Oxfordshire PCT are currently creating serious waves within the coeliac community with a consultation document on withdrawing funding for prescription gluten-free food for coeliacs. Their reasoning runs as follows:
• There is now a wide range of gluten-free foods in supermarkets, eg, gluten-free pasta, pizza bases, cakes and breads
• There is a good choice of various makes of gluten-free food
• The cost of gluten-free foods is not as high as it used to be
• Non-wheat, barley or rye based foods that provide carbohydrates are readily available, eg potatoes and rice.
• The NHS does not provide prescription food for other groups of patients whose diseases are associated with, or affected by, the the type of food they eat.
They also point out that their PCT is under financial strain because the population of Oxford is growing, more people are living to an older age, the cost of medicines are rising etc etc etc. What they do not say, although of course it is also true and certainly adds to the strain on their finances, is that whereas 30 years ago, when the gluten-free food on prescription was introduced, less than one in 300 people were diagnosed as coeliac, the number has now risen to somewhere between in in 70 and 100 – a 200% increase in the number of coeliacs to be fed.
All the points that they make about the availability of gluten-free food also happen to be true. There is a very much wider range of it available in a very much wider range of outlets, its price is dropping (although it remains significantly more expensive the gluten-filled food) and there are plenty of alternative carbohydrates available to coeliacs or anyone else who chooses not to eat gluten. It is also true that the gluten-free food that is on offer in retail outlets can often (though absolutely not always) be better quality and more appealing than what you can get on prescription.
So, if have to pay for your prescription, although shop-bought gluten-free food may still cost you slightly more, the extra cost may not be that significant and the choice and convenience could be a good deal greater.
The rub, and the concern, is for those who do not pay for prescriptions – babies and children, pregnant or lactating women, the elderly, those with specific physical disabilities and those on benefits of various kinds. For them, getting gluten-free foods on prescription may be the only way that they will be able to get them as they may not be able to afford to pay the extra premium for them in the shops. If they are not able to get gluten-free food on prescription, although they could, in theory, achieve a gluten-free diet by using other cheap carbohydrates such as potatoes and lots of culinary imagination, the chances are that they won’t and that they may therefore damage their health more or less seriously by eating foods which contain gluten.
So should prescription g-f food be available only to those who are entitled to free prescriptions? In principle, that seems a sensible way to go. But, will the drop in volume mean that it may not longer be commercially viable for those companies currently supplying the NHS to continue to do so and that they therefore will turn purely to the retail market?
Alternatively, should those who currently are entitled to free prescriptions for g-f food just be given extra money instead to cover the cost of buying their g-f food in the retail sector? This would certainly be a cost effective option for the NHS but, what guarantee is there that the money would actually be spent on gluten-free food? When money is short, paying the electricity bill may seem more important that buying gluten-free food.
Maybe a possibility could be some version of Green Shield stamps which could be provided for those coeliacs who would have received gluten-free food on prescription which they could exchange, in major supermarkets and other participating stores, for gluten-free foods, and only for gluten-free foods?
I am not saying that this is the answer, but as the availability of gluten-free food increases and as the price drops providing it as a standard prescription food becomes more and more questionable. While just dropping it may not be the answer, some creating thinking is definitely needed.
Meanwhile, if you wish to take part in the Oxfordshire consultation, click here.
I do not agreed that all Gluten Free food should taken off of presciption. I was diagnosed with coeliac disease 20 years ago and while I agreed that there is more food readily available now, it is still very costly. Why is it that someone with the Coeliac condition has to pay almost double for food such as bread. I think that if we had no food on prescription it would cost the health authority twice as much because people would not be able to follow the diet properly leading to more health problems.
May be there needs to be a review and a strict limit put on what can be prescribed.
Whilst I agree that the cost for the NHS for GF foods is cause for concern, as a Coeliac of 37 years since diagnosis and now retired, I feel that the minimum the NHS should do is to prescibe bread for us.
As far as I am concerned biscuits etc should be at the patients expense. Perhaps this is how the cost has escalated in recent years.
Hi Clive – Actually, I think that would be a quite good way to go and I think that is also the way that many PCTs (and companies manufacturing prescription products for coeliacs) have been going – just provide the staples (bread, flour, pasta) so that those who cannot afford to buy them will not endanger their health, but no luxuries.
But there’s an occasional case to be made for prescribing a ‘luxury’ – for instance, with a severely underweight newly diagnosed coeliac, who may benefit from some high calorie / high fat product such as cake in the diet. I do recognise that having ‘treat’ items on the lists, though, make it easier for those against prescriptions of GF food for coeliacs to argue their case – just the sort of thing the Daily Mail may pick up and trumpet!
It’s a hard one with no real answer. When I met my husband he had been coeliac for about 5 years or so, was a single lad and had a low income. He absolutely relied on pasta and bread on prescription. He has type1 diabetes too and has done all his life. I know for a fact that if he was not in receipt of pasta & bread then he would have been buying supermarket “value” bread etc, i.e. not gluten free.
We are a bit older now, have two wee ones and only one wage. We still struggle for money but we are more sensible with that money and choose to get Glutafin bread mix (5 boxes) on prescription about once every 3 months. We buy DS brown ciabattas (the ONLY tasty bread product readily available) and frozen sausage rolls, steak pies etc ourselves. We buy Doves Farm flour and make stuff ourselves. That’s because we are able to. As mentioned above, if it came to deciding between electricity bill and gf food then we would be calling for more prescriptions. I guess I don’t actually have a point. We used to rely on prescriptions but now we don’t. Although still entitled to it we feel that the NHS already do enough for us, but we’d like to think they still would if we needed it!
I was diagnosed coeliac 4 years ago.I fully appreciate the NHS is struggling to meet everyones needs but I do not think a few loaves of bread every couple of months is stretching them. It bothers me that alcoholics and drug takers get medication to keep them well and this is never an issue, an unnecessary drain on the NHS in my humble opinion, their own doing!! But coeliacs have to make their money stretch further to buy basics like breads and pasta which is quite costly. I get 10 loaves every 8-10 weeks, i dont think its alot.
Those who live in rural communities which are poorly served by supermarkets rely on their GF prescription food. There are many areas where it is not possible to get even the basic GF requirements such as bread and pasta from a local shop or even via a supermarket delivery. If GF food was not available on prescription these people would have the added expense of buying GF food online incurring delivery charges or buying through their pharmacy which can be even more expensive. My daughter who has coeliac has had no other prescriptions in the 8 years she has been diagnosed and her only use of the NHS has been the GP for yearly check-ups.
My argument, is that if you live in a town, then you have access to GF foods. If you live in a rural village and you take away GF foods (what little choice there is) from prescription, where do we get it from?
Dear Daphne and Jane –
Do entirely take your points about availability of gf food in rural areas. But I still wonder if you might not be better served by a voucher system which allowed you to access retails gf foods through an online delivery service such as, for example, GoodnessDirect? You would still get the financial assistance but would have a great deal more choice in how you use it.
Maybe a coeliac tax break is the way to go? That is what they do in Canada. An interesting article in the CBC Calgary news – see here http://www.cbc.ca/news/canada/calgary/story/2012/02/13/calgary-celiac-tax-break.html